What is the ABA insurance mandate?
New Jersey passed a mandate, P.L. 2009 c. 115 Health Benefits Coverage for Autism and Other Developmental Disabilities in 2009. Click here for the information:
This law requires fully-insured plans written in New Jersey to cover screening and diagnosis as well as medically necessary physical therapy, occupational therapy, speech therapy and ABA therapy for autism and other developmental disabilities. Prior to authorization, insurance carriers will require a current medical prescription with the ASD diagnosis.
Does my insurance cover ABA services?
Coverage for ABA services is dependent on whether your plan is fully funded or self-funded. Self-funded plans are not included under the mandate and may not necessarily cover services. If your insurance carrier does cover services, deductibles and copayments will apply as with any medical procedure or office visit. Contact us and we would be happy to speak with you about your options.
Can Pediatric InterActions assist with this process?
At PI, our office staff is here to help with any insurance inquiries. Navigating the insurance process can be overwhelming. We will verify benefits for services, determine preauthorization needs and provide a detailed summary of your coverage. Just give us a call.